Dental Tribune USA

Treatment acceptance: could have, should have, would have

By Sally McKenzie, CMC
July 07, 2009

When it comes to treatment acceptance — or lack thereof — it seems as though a lot of time and energy are wasted on that familiar trio ‘could have, should have and would have.’ You spend hours analyzing how things could have been if you had just used a different approach. How things should have been if you had just taken more time to educate the patient on why the treatment was necessary. How things would have been if you had listened more carefully to the patient.

Oftentimes, dental teams mistakenly view the treatment presentation as a one-time event that is a make-it-or-break-it situation. You either win or you lose based on that 15-minute song and dance. In reality, patient treatment acceptance begins long before you sit across from him or her eager to present the best that your dentistry has to offer. Consider our patient, Mary, who goes to Dr Smith’s office.

“Dr Smith’s office is great for cleanings and that, but he always seems so rushed. He takes a quick look at my teeth after the hygienist cleans them and sends me on my way. I want to ask about veneers, but I never feel like I should bother him with questions,” Mary says.

Dr Smith, meanwhile, is befuddled when patients don’t accept recommended treatment. Yet he gives little thought to the manner in which he and his team build, or erode, the foundation upon which successful treatment acceptance is based.

In Mary’s case, Dr Smith doesn’t realize that he is undermining Mary’s trust in his care. Mary will be far less likely to proceed with recommended treatment because Dr Smith has created the impression that he is always in hurry to get to the next patient, which makes her feel uneasy and unimportant. Worse yet, Mary is interested in a certain procedure but doesn’t even feel comfortable asking about it.

It’s a matter of trust

Certainly, patients trust you enough to come in for routine appointments. But when the patient needs or wants care that goes beyond “routine” procedures, have you and your team instilled in the patient the confidence, the dental education and the necessary trust in you and your practice overall for him or her to accept the treatment recommended?

In some cases, patients are motivated to pursue treatment merely because they seldom question recommendations from their health care providers. But those patients are growing fewer and farther between each year.

Most patients today base major decisions, such as extensive dental treatment, on multiple factors: full comprehension of the need for treatment; the importance of the procedure to them in terms of quality of life, esthetics or health; possible ramifications if they choose to procrastinate or elect an alternative procedure; and how they feel about the practice as a whole.

Recommendation acceptance

When it comes to treatment presentation, we find that most dentists and teams understand the fundamentals of the concept, but they forget that patients base their recommendation acceptance on multiple factors.

In addition to always treating every patient as if she or he is the most important person in the room with you, and always taking the time to solicit questions from the patient, consider a few other ways in which you build trust with every patient and at every opportunity.

Be candid. Most patients are aware of some general risks in treatment so they are waiting for you to be frank about what, if anything, they might be faced with as a result of the treatment. If they are given advantages and disadvantages, research shows that patients are more willing to trust you to deliver their care. Patients always feel better when they know the benefits and risks of proposed treatment.

Always speak at the patients’ level of understanding. Jargon and “$10 words” can confuse patients and make them uncomfortable because they don’t understand, but they likely won’t ask you what you mean.

Exhibit clear confidence in your recommended course of treatment. A personal testimonial about recent treatment for another patient and the results obtained, for example, underscores that sense of security. It demonstrates that you have no doubt that you will get a good result for this patient.

Be aware of the perception of “fairness.” Many issues having to do with trust are linked to the patients’ perception of the value they are receiving. Studies show that patients avoid dental treatment due to cost more than pain. Yet, if they feel that the costs measure up to the service received, there is no complaint. Many patients will not question fees if the practice has demonstrated that they can deliver superior service. From the first phone call to dismissal, consistently demonstrate the “value” for services that the patient is receiving.

Many patients today expect more than just a routine visit. They are smart, savvy and are much more aware of recent advances in dental care and treatment options than patients 20 years ago. Numerous patients would love to change something about their smile or improve their oral health, but few will verbalize those desires without prompting. Others have concerns, but don’t want to appear foolish in raising them. Yet, if new and existing patients feel that the dentist and dental team are sincerely interested in their needs, wants and concerns, they are far more likely to be open to the treatment recommended.

Encouraging acceptance

Follow these steps to set the tone for patient treatment acceptance.

  • Create a comfortable, non-rushed environment when explaining treatment. Don’t have the schedule booked so tight that you are perceived as being in a rush. Patients need to feel that they are important and worthy of your time.
  • Explain in simple language
  • the reasons the procedures are necessary. Choose language that fits the patients educational level of understanding and speak slowly, using pictures to illustrate.
  • Explain the steps of the procedures and how many appointments and how long each appointment will take. Explain to the patient how you will make her/him comfortable during treatment and what options are available, such as anesthetic.
  • Ask the patient questions to detemine if she/he has any false ideas about treatment. (Many patients still think that root canal therapy involves removing the roots.) Use educational tools, such as chairside videos or other visual aids. When using video or other educational aids, summarize what the patient has viewed and ask if there are any areas that need further explanation.
  • Be empathetic to the patient’s concerns about the condition of the teeth. Don’t make the patient feel that his/her mouth is a “mess.” Patients who have postponed dental care are often embarrassed and don’t want to be perceived as neglectful or hopeless. Encouragement coupled with kind words can build trust and respect.
  • Explain alternatives to the
  • treatment. Make sure the benefits and the possible risks to the procedures are understood. Informed consent in writing is necessary when there are risks and when the outcome could be less than favorable.
  • Look the patient in the eye
  • when discussing treatment. Sit at the same level as the patient and lean slightly forward to show interest and care. You will be able to listen to and observe the patient’s response more readily.
  • Smile and nod your head in understanding as the patient responds to the presentation. This is proof to the patient that you are truly listening to each word said.
  • Never turn away from the patient while she/he is speaking. Not only is this rude, but it also shows that you are not listening to what the patient is telling you.

Certainly, presenting treatment to patients requires skill and understanding of patients’ needs. Many people learn these skills by trial and error, which can be quite costly. If treatment acceptance is a struggle among either new or existing patients, or both, it’s time to find out exactly where this critical system is breaking down.

Contact Sally McKenzie at


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